Experience Of Tele-Expertise In Cardiology In Pays De La Loire

Introduction: General practitioners regularly need specialized advice for therapeutic adaptation, ECG interpretation or to facilitate referral to the local cardiologist. Tele-expertise could amplify these possibilities of coordination between professionals. An experiment in tele-expertise in cardiology was carried out by the URML in Pays de la Loire between 2016 and 2017. This experiment allowed GPs to seek the advice of a liberal cardiologist via a link card. The cardiologist received the card, accompanied by the ECG and responded within 48 hours.Objectives: The objective was to study the acceptability of the experiment and to study the impact on the coordination of health care professionals and on delays.Method: This evaluation required a mixed methodology with a before/after the experiment survey, semi-directive interviews with GP and cardiologists, ad hoc data collection and data from national health insurance claim database.Results: In 15 months of experimentation, 22% of GPs and 52% of liberal cardiologists of the territory participated. 959 reviews were requested by the GPs or 74 cards per month. The cardiologists were solicited 2.3 times a month. The cardiologist rated the ECG abnormal or doubtful for 31.9% of exams. An appointment was scheduled on average within 24 days. Few difficulties in using the service have been reported by users.Discussion: The results show that tele-expertise without any complex computer tools to work, helps to improve the organization of the gradation of the response of the specialized offer, to improve the confidence of GPs in their own ECG analysis. It constitutes a full-scale observatory of the implementation of tele-expertise in cardiology, upstream of its generalization announced for 2020 in France.